Evaluation of the different technique for repair of distal hypospadias

Hypospadias is one of the most common congenital anomalies occurring in approximately 1:520 to 1:300 live births [Baskin, 2000]. Hypospadias in boys, may be defined classically as an association of the penis: 1. An abnormal ventral opening of the urethral meatus, 2. An abnormal ventral curvature of the penis [chordee]; 3. An abnormal distribution of the foreskin, with a hood present dorsally and deficient foreskin ventrally [Mouriquand et al, 1950]. The aim of this work was to adequately describe the abnormal anatomy met with distal hypospadias cases and to evaluate the results of repair of distal hypospadias comparing the results of the different techniques of repair to be aware about the most suitable technique. This study was done on 40 patients with distal hypospadias in the age range 6 months to 12 years in the period from October 2004 to October 2005 in Plastic Surgery Department, Sohag university Hospital. Full history, clinical examination and routine investigations was done for every patients. We used three operative procedures: a-Tubularized incised plate urethroplasty [Snodgrass] [TIP], be-Meatal based flap [Mathieu] repair, and c-Meatal advancement and glanuloplsty incorporated technique [MAGPI]. Pin hole meatus was the commonest finding to be present in association with hypospadias in this study [12.5%]. Edema is the most common complication in the early postoperative period; represent, 83% in Mathieu, 80% in TIP75% in MGAPL. As regard the chronic complication, fistula is the most important complication of hyospadius repair, it was recorded in 4 out of 20 cases with TIP repair, 3 out of 12 cases with Mathieu repair and one case out of 8 cases with MAGPI repair

Early experience of autologous breast reconstruction after mastectomy: accebtability, complications, and outcome

Introduction and aim of the work: Breast reconstruction after mastectomy became well accepted during the past 20 years and it is now an essential part of the interdisciplinary treatment for breast cancer. We aimed in this study to offer the Egyptian women the option to obtain a nearly normal looking breast after mastectomy and to assess the complications, esthetic results and patient satisfaction

Patients and methods: from January 2003 to June 2004, 12 patients were offered and accepted post mastectomy autologous breast reconstruction using either Transversus rectus abdominis myocutaneous [TRAM] 0r Latissimus dorsi myocutaneous [LDM] flaps. Esthetic results, complications and outcome were recorded

Results: Four patients were reconstructed by pedicled TRAM fIap and 8 patients were reconstructed by LDM flaps. The mean age was 46.6 year and the mean BMI was 29.8. Mean operative time for mastectomy was 77. 8 min. and the mean operative time for TRAM flap was 130 min. versus 95. 6 min. for LDM flap. Seroma in the back occurred in 3 cases in LDM flap. Partial flap necrosis and delayed wound healing each occurred in one case in TRAM flap. Esthetic results and patient’s satisfaction were good in both groups except in two patients

Conclusion: Breast reconstruction after mastectomy in our locality is still not gaining popularity and had low acceptability rate. Autologous breast reconstruction with TRAM or LDM flap gave good esthetic results and satisfaction in most of our Patients with few complications. Proper patient selection is the key for success of this reconstructive surgery